Panic attacks can last from anywhere between thirty seconds to thirty minutes and can be so distressing sufferers sometimes have the feeling they are losing control or about to die. The experience can be one of extreme agitation, terror, fury, or immobilisation, accompanied by extreme symptoms of the fight, flight, or freeze response; racing heart, rapid breathing, trembling, shaking, nausea, numbness, tight chest, difficulty swallowing, and hot flushes or chills. Episodes can return in waves, are frightening and often exhausting.

Panic attacks are normally initiated when the amygdala responds to a trigger in the environment the person may or may not even be aware of. They can be triggered by situations, smells, sounds, or feelings; based on deeply held fears or associational memory. They can often occur at inappropriate times and are due to an overreaction by the amygdala, often in response to a cue or trigger that doesn’t pose any real threat or danger. If there was a real danger or emergency then the physiological responses would be appropriate and helpful.

Most people will experience some sort of panic attack once or twice in their lives, but those who have more regular panic attacks can start to fear them, and this anxiety can become a self-fulfilling prophecy, with an attack being triggered simply by the fear of having one. For example, a person may once have had a panic attack at the cinema, so during their next visit to the cinema they fear the same thing happening again, which can start to trigger panic attack symptoms. This can lead to the person avoiding the cinema altogether, and then avoiding other public places in the future.

Important: Don’t Try to Escape the Situation!

When suffering from a panic attack it’s vital you resist the strong impulse to escape the situation. Although panic attacks are very frightening and uncomfortable they can’t physically hurt you. Fleeing from the situation may make you feel better in the short-term but in the long-term it will reinforce the power of the attacks, and make it more difficult to overcome them. The amygdala learns from experience. So staying in the situation will help the amygdala to learn that the situation is safe and it doesn’t need to react in the same way in the future. While this is much easier said than done, it would be beneficial to see these situations as opportunities to work on changing the anxiety response; reducing, and eventually eliminating further episodes.

What to do when you feel panic rising

Although it is very difficult to calm a panic attack through logical thinking, there are some things you can do during a attack that will help reduce the ability of the prefrontal cortex to create the conditions in which the panic attack can get worse:

1 . Understand it’s only a feeling: Interpreting the symptoms of a panic attack as life threatening can cause the symptoms to get a lot worse. So it’s important to try to recognise you are having a panic attack and nothing more. This will ensure you don’t add fuel to the flames.

2. Don’t worry about what other people think: In the middle of a panic attack people often feel embarrassed and worried other people are judging them. Don’t let your cortex try to predict what other people are thinking, it is probably wrong anyway, and it will only add to the stress and panic.

3. Don’t focus on the panic attack: Try not to obsess about when a panic attack may come. Not worrying about panic attacks is one of the best ways to avoid them. Constantly focusing on bodily sensations like sweating and butterflies in the stomach, can lead you to thinking yourself into a panic.

Exercises to use in the middle of an attack

So what should we do if we start to recognise symptoms of a panic attack starting, or if we suddenly become aware we’re caught up in one? How can we best cope? While we can’t immediately stop the attack, there are a number of strategies that can reduce the power of the symptoms and also shorten the duration of the attack. These strategies are designed to help us switch from the aggressive sympathetic nervous system to the calmer parasympathetic nervous system.

Always keep in mind that in order to eliminate or greatly reduce future panic attacks you need to try to avoid escaping the situation. This can be difficult at first and will require patience and courage, but with time and practice it will get easier. Experiencing short-term fear will provide you with long-term peace.

Panic Attack Exercise: Deep Abdominal Breathing

Deep breathing can be effective when having a panic attack as many of the symptoms we experience are related to hyperventilation, which is fast and shallow breathing. When we go into hyperventilation, we breathe out carbon dioxide too quickly, resulting in low levels of it in the body. This is identified immediately by the amygdala and triggers a highly reactive response. This is why people who are having a panic attack are advised to breathe into a paper bag; the bag will capture the expelled carbon dioxide, allowing it to be inhaled back into the bloodstream.

By using conscious deep breathing we can relax the amygdala and prevent hyperventilation, or bring it under control after it has been triggered.

Step 1Sit as comfortable as you possibly can, placing one hand on the chest and one hand on the stomach. If you’re unable to sit down you can still do this exercises standing up.

Take a deep breath in and see which part of your body rises. People often find that their chest rises as they breathe in. However, effective abdominal breathing will cause your stomach to expand as you inhale and retract as you exhale. Your chest shouldn’t move much at all.

Step 2Try to focus on breathing deeply in a way that expands your stomach as you fill your lungs with air. You should feel your stomach rising underneath your hand when you breathe in. Many people tend to pull their stomachs in as they inhale, which keeps the diaphragm from expanding downward effectively. So focus your attention on your stomach rising as you inhale.

Physical Exercise

If you’re in a place where you’re able to move about when having a panic attack it would be very beneficial to pace or exercise. Remember, this is the emergency arousal system kicking in, preparing your body to fight or flee, so physical exertion is exactly what your body is ready to do. If your sympathetic nervous system is activated, you can put it to use as nature intended.

If you run or walk briskly when you feel anxious, you’ll make use of the muscles that have been prepared for action. Exercising will also burn off excess adrenaline and make use of the glucose released into the bloodstream by the stress response.

Many of the physical sensations you experience when exercising are similar to the way the body reacts when the emergency arousal system has been activated; increased heart rate and blood pressure, faster breathing. So exercising can also be a form of exposure therapy, allowing you to experience and get used to these types of physical changes, making us less afraid and more accepting of the sensations over time.

If you found this article helpful and want to more detailed instructions and further exercises, they are available in my books: Overcome Anxiety and Overcome Social Anxiety and Shyness are available on Amazon in the U.K.and the U.S.A.

My Online Course: Overcome Anxiety and Panic Attacks — A Self Help Workbook Course for Anxiety Relief and Panic Attacks is available at a discounted price on Udemy by using this link